Anesthesia Management in a Patient with Vagal Nerve Stimulator Requiring Emergency Surgery

Vagal nerve stimulation (VNS) is a method used in patients with drug-resistant epileptic seizures. Apart from epilepsy, it has also been used in migraine, chronic pain and depression. Obstructive sleep apnea, aspiration of gastric contents, vocal cord paralysis, hoarseness, dyspnea and cardiac arrhythmias are common complications in patients with VNS and may cause problems in anesthesia applications. A 25-year-old male patient was scheduled for an emergency operation by orthopedics due to a deep incision and active bleeding in the right knee. The patient was mentally retarded and non-cooperative, and his cardiac and respiratory system examination was normal. The patient, who has had epilepsy since the age of 3, had a VNS device inserted 2 years ago. Blood biochemistry, hemogram and coagulation parameters, ECG, chest radiography and neurology consultation were requested. He was operated on without any intervention to the VNS device. General anesthesia was applied and the patient was intubated. BIS monitoring was applied, there was no problem in the intraoperative period, he was taken to the intensive care unit in the postoperative period. It is recommended that the VNS device be turned off or reprogrammed prior to elective surgery. In emergency situations, the device may not be intervened in any way. Using LMA is not recommended as it may cause airway obstruction. In intubated patients, stimulation of the vagus may cause damage to the vocal cord. Seizures may occur in the perioperative and postoperative period. In the postoperative period, the patient should be followed closely due to respiratory problems and obstructive sleep apnea. Anesthesiologists should be aware of the technical features of non-cardiac implantable electrical devices, side effects and problems that may be encountered during anesthesia applications.